0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Reviews |

Botulism in the United States: A Clinical and Epidemiologic Review

Roger L. Shapiro, MD; Charles Hatheway, PhD; and David L. Swerdlow, MD
[+] Article and Author Information

From the Centers for Disease Control and Prevention, Atlanta, Georgia (Hatheway) Deceased Requests for Reprints: David L. Swerdlow, MD, Centers for Disease Control and Prevention, 1600 Clifton Road, MS A-38, Atlanta, GA 30333. Current Author Addresses: Drs. Shapiro and Swerdlow: Centers for Disease Control and Prevention, 1600 Clifton Road, MS A-38, Atlanta, GA 30333.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1998;129(3):221-228. doi:10.7326/0003-4819-129-3-199808010-00011
Text Size: A A A

Botulism is caused by a neurotoxin produced from the anaerobic, spore-forming bacterium Clostridium botulinum. Botulism in humans is usually caused by toxin types A, B, and E. Since 1973, a median of 24 cases of foodborne botulism, 3 cases of wound botulism, and 71 cases of infant botulism have been reported annually to the Centers for Disease Control and Prevention (CDC). New vehicles for transmission have emerged in recent decades, and wound botulism associated with black tar heroin has increased dramatically since 1994. Recently, the potential terrorist use of botulinum toxin has become an important concern.

Botulism is characterized by symmetric, descending, flaccid paralysis of motor and autonomic nerves, usually beginning with the cranial nerves.Blurred vision, dysphagia, and dysarthria are common initial complaints. The diagnosis of botulism is based on compatible clinical findings; history of exposure to suspect foods; and supportive ancillary testing to rule out other causes of neurologic dysfunction that mimic botulism, such as stroke, the Guillain-Barre syndrome, and myasthenia gravis. Laboratory confirmation of suspected cases is performed at the CDC and some state laboratories. Treatment includes supportive care and trivalent equine antitoxin, which reduces mortality if administered early. The CDC releases botulism antitoxin through an emergency distribution system. Although rare, botulism outbreaks are a public health emergency that require rapid recognition to prevent additional cases and to effectively treat patients. Because clinicians are the first to treat patients in any type of botulism outbreak, they must know how to recognize, diagnose, and treat this rare but potentially lethal disease.

Topics

botulism ; toxins

Figures

Grahic Jump Location
Figure 1.
Schematic representation of the action of botulinum toxin (BT) on a neuromuscular junction.

Ach = acetylcholine.

Grahic Jump Location
Grahic Jump Location
Figure 2.
Annual incidence of botulism in the United States, 1973 to 1996.

The line interspersed with dots indicates botulism in infants, the solid line indicates foodborne botulism, the short-dashed line indicates wound botulism, and the long-dashed line indicates botulism from an undetermined source.

Grahic Jump Location

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Botulism as a food poisoning: what is it? J Egypt Soc Parasitol 2014;44(1):211-20.

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)